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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on October 30, 2011, at 7:32:17
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 30, 2011, at 6:40:38
> I dont think Zoloft does interact with the TCA's, seretonin syndrome with amitriptyline must be extremely rare, it is generaly felt that the only TCA with enough seratogenic activity to cause seretonin syndrome is clomipramine.
Imipramine can also precipitate SS when combined with a MAOI. It did in me, although it was relatively mild. I experienced severe hypotension, hyperreflexia and muscle rigidity while I was taking imipramine and Nardil together. I had to crawl around my apartment to keep from fainting.
- Scott
Posted by Abaigeal on October 30, 2011, at 9:12:15
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » jono_in_adelaide, posted by SLS on October 30, 2011, at 7:32:17
Well I wasn't taking anything else. Oh and while I was sleeping for 3 days, I would occasionally wake up and take more amitriptyline, which I don't remember doing.
Posted by Peter Heuer on October 30, 2011, at 15:39:34
In reply to Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 20:23:10
Amitriptyline plus SSRI-drugs is a bad combination of medicines.
I was on Elavil and Prozac for a while, and that was the worst time of my life.
The psychiatrist that prescribed these two drugs for me was incompetent.
I have fired him long time ago. Now I'm my own doctor.
Peter Heuer
Posted by jono_in_adelaide on October 30, 2011, at 18:21:23
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 30, 2011, at 9:12:15
You were in a hospital,and they were letting you self administer meds? What sort of a hospital was this?
Posted by jono_in_adelaide on October 30, 2011, at 18:25:44
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Peter Heuer on October 30, 2011, at 15:39:34
The danger with prozac/paxil and a tricyclic is because paxil/prozac inhibit the metabolism of tricyclics, so your blood levels go sky high. A tricyclic plus either Zoloft or Celexa is very safe and cmmonly used (Usualy nortriptyline is used because it has less side effects like sedation than amitriptyline)
Posted by jono_in_adelaide on October 30, 2011, at 18:27:32
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Peter Heuer on October 30, 2011, at 15:39:34
Scott, thats interesting..... maybe it would be wise for people taking these combination approaches to have a few tables of Periactin on hand incase SS does develop - 2 Periactin will stop the syndrome in its tracks (along with stopping the offending drug of course)
Posted by Phillipa on October 30, 2011, at 18:44:06
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 23:52:09
Could you reply to the questions of the hospital letting you self administer meds when in the ER? Phillipa
Posted by Abaigeal on October 30, 2011, at 19:25:50
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 30, 2011, at 18:44:06
They did not, they dosed me up every 2 hours or so. But I am now self administering since I've been out of the hospital
Posted by Phillipa on October 30, 2011, at 20:54:05
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 30, 2011, at 19:25:50
Thanks for answering. We get concerned when someone doesn't repost after being so ill. Things any better now? What is your docs plan for meds for you? Phillipa
Posted by creepy on October 30, 2011, at 22:09:00
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 30, 2011, at 6:40:38
Lots of interactions with these two classes of medication. Its important to know since it gets missed. Especially nowadays with docs squeezing patients with multiple meds into 10minute windows. Its no wonder theres so much concern over liability =(
Heres the study on sertraline + desipramine if anyones interested
http://www.ncbi.nlm.nih.gov/pubmed/9241008
Posted by creepy on October 30, 2011, at 22:10:53
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » jono_in_adelaide, posted by SLS on October 30, 2011, at 7:32:17
I could see desipramine with an MAOI.. but not a serotinergic one like imipramine. Im guessing you were experimenting since other options didnt work out?
Posted by Abaigeal on October 31, 2011, at 6:14:55
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 30, 2011, at 20:54:05
things are...okay right now. I get extremely sick at least once a day where I can't do anything, just lay on the couch, chest pains, nausea, angry all the time, I've had a headache for at least a month... I have no idea what to do! The doctors don't know sh*t yet.
Posted by jono_in_adelaide on October 31, 2011, at 6:47:35
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 6:14:55
"Thus, when coadministered with 50 mg/day desipramine, sertraline had significantly less pharmacokinetic interaction than paroxetine with desipramine at the recommended starting dosages of 50 mg/day and 20 mg/day, respectively."
I dont think that suggests there are significant interactions between sertraline and desipramine.
Posted by Abaigeal on October 31, 2011, at 10:36:11
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 6:47:35
amitriptyline is a totally different drug, it's old as f*ck. I'm getting extremely agitated, and I don't know what to do. I can't sleep for more than 2 hours.. ugh
Posted by jono_in_adelaide on October 31, 2011, at 17:35:00
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 10:36:11
OK, have you tried a mild sleeping pill, such as ambien?
Have you considered that the symptoms you are getting are because of the condition that led you to a psychiatrist, rather than your misadventure with meds?
Try and not get into the victim trap of blaming everything wrong in your life on that one misadventure.
I'd ask your doc for a mild sleeping pill, take a simple analgesic for the headaches (for example Exedrin) and perhaps go back on another antidepressant, such as mirtazapine (Remeron)
Posted by dove on October 31, 2011, at 17:39:08
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 10:36:11
Do sleep meds like Ambien or Lunesta trigger serotonin effects? Could she take something like that to help with sleep, or something along the lines of Gabapentin or Lyrica?
Posted by Abaigeal on October 31, 2011, at 18:19:07
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 17:35:00
Okay, right now, I have no idea what is going on with my brain. I'm trying to get some ideas of what to tell the psychiatrist tomorrow. I keep going from being happy to angry, to anxious, panic attacks, sad, hopeless. And not sleeping well, with a headache all the time, does not help. I've never been like this before. Is it possible amitriptyline has been covering up the onset symptoms of maybe bipolar disorder?
Posted by Phillipa on October 31, 2011, at 18:59:03
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 18:19:07
I feel anything is possible. You do need sleep though. Will you post what your doc says? Maybe call? Phillipa
Posted by dove on October 31, 2011, at 19:06:30
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 18:19:07
Bipolar is treated with mood stabilizers and "usually" more extreme with more definitive highs and lows. Not saying a mood stabilizer would be of no use but remember that you are coming off of 2 years of amitriptyline use cold turkey. There are going to be some rough edges for a while (particularly when losing both the zoloft and ami). I had lots of mood changes and volatility when I quit taking ami.
Tell the p-doc what you are feeling, you don't need a "label" to receive help, they need to treat the symptoms you are currently feeling if possible, help ease the withdrawal. Write a list, have something in hardcopy to read so you don't get flustered and forget the important things that are seriously disabling you.
Hopefully the doc has experience treating patients who have had serotonin syndrome. There are other classes of meds that should help ease some of the symptoms or at least make them somewhat manageable.
Posted by dove on October 31, 2011, at 19:20:56
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 17:35:00
Mirtazapine is contra-indicated after severe serotonin syndrome I thought? Could she utilize a straight NRI? Like Reboxetine (panic and depression)? Or even Bupropion (depression)? Not sure what affinity bupropion has for serotonin receptors anymore... Use ambien or lunesta or something for sleep help.
Migraine help is most likely not going to some from exedrin (at least that didn't help mine which was why I was started on amitriptyline originally). Gabapentin or calcium channel blocker for migraine, I don't know.
Posted by jono_in_adelaide on October 31, 2011, at 19:31:28
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 18:19:07
amitrioptyline is more likely to trigger bipolar than cover it up, it has probably masked the headaches and depression though.
I'd ask for a sleeping pill for a while (Ambien for example) and discuss the possability of taking an antidepressant like nortriptyline, this will help the headaches, help with your sleep, and help with anxiety/depression.
Usual dose would be 75mg at night. An alternative would be remeron, this would be better for anxiety, about the same for depression, perhaops not so strong against headache.
Posted by Abaigeal on October 31, 2011, at 19:50:33
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 19:31:28
I've been on remeron twice before, the first time I got really bad RLS, second time it made my anxiety go crazy. I will ask for a sleeping aid. I was reading that amitriptyline is sometimes used for people with bipolar. And I don't know a thing about nortriptyline.
Posted by Abaigeal on October 31, 2011, at 20:04:31
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 19:50:33
"Nortriptyline is the active metabolite of amitriptyline that is demethylated in the liver. It inhibits the reuptake of norepinephrine (noradrenaline) and, to a lesser extent, serotonin with negligible effects on dopamine reuptake. Nortriptyline also has antagonistic effects at a variety of receptors"
It effects serotonin, I'm not supposed to ever take anything that affects serotonin??
Posted by jono_in_adelaide on October 31, 2011, at 20:17:28
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 20:04:31
Nortriptyline is very safe, it is highly selective for noradrenalin, I dont think it has ever been associated with seretonin syndrome, it is commonly used in combination with SSRI's
Taking it by it self without an SSRI there would be no risk at all.
Ask your doctor and see what he says, the worst he can say is no.
I'd ask about taking nortriptyline 75mg at bedtime, and 10mg ao Ambien at bedtime if needed/when needed
Posted by Abaigeal on November 1, 2011, at 7:01:47
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 20:17:28
So I went to bed around 12, woke up at 3, was drawing and listening to music til like 5.. then I got really sick, started hyperventilating, took my ativan, but then I started hallucinating again, just latices and uncontrollable shakes. I do not understand what is going on. Was it just from the hyperventilating? Lack of oxygen? The ativan is finally kicking in. I just want to sleep and not have this headache!
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